Sunday, January 8, 2017

2017 - The Year of Saying No

I suspect that I'm not the only person in medicine who is a people pleaser.  Since elementary school, I've always been very academically successful, and the resultant praise from teachers and relatives has given me a lot of pleasure and personal satisfaction.  Going to medical school and becoming a doctor took this to the next level, as suddenly patients and even strangers were regularly praising me for the work I did. 

The big problem with getting so much validation externally is that you start to be dependent upon it.  You need people to tell you how important you are and how no one else can do what you're doing.  And so you constantly seek ways to keep that validation coming.  You say yes to giving one more presentation or fitting another patient into your clinic or teaching one more tutorial.  Even when you don't really want to be doing any of those things.

Over the past few months, I've been feeling depleted, as I keep telling my partner.  I've been feeling overwhelmed by work; I've been having difficulty sleeping; and I've been hit with a bone-weary exhaustion that reminds me of my residency days.  I had hoped that a recent trip to a cabin would fix things, but four days away just wasn't enough.  I'm tired. 

And despite this, people keep asking for more.  Start a research project.  Do more training.  Teach another academic half day.  More, more, more, when all I want to do is stay in bed with my cats.  It has reached the point where I feel anxious not only when my pager goes off, but also when my inbox pings, signalling the arrival of another email asking for my time and energy.

So this year, I'm going to learn to say no.  Thank you for the opportunity, but that isn't my priority.  My priority needs to be finding balance, a level of work and engagement that I can happily sustain for the next 20 years, not saying yes to every single request that comes my way.  I need downtime and sleep and yoga classes and running and home-cooked food and time with the people I love, not another item on my to-do list.


It sounds straightforward, but it goes against the very essence of medical culture.  Physicians pride themselves on being able to work a 28-hour shift and then go climb a mountain on their post-call day.  Medicine is the North American worship of busyness and achievement taken to the extreme.  Saying no means being inadequate and not measuring up to the standard.

And Medicine doesn't always listen to no.  A few weeks ago, I was emailed a request to help someone out with a presentation.  My stomach sunk when I read the email, because it was something that I really didn't want to do, even if I had had an abundance of time in which to do it.  So I sat on the email for weeks, debating the merits of saying yes versus no, until I finally got up the guts to sent a polite email declining the request.

The response?  Within seconds, a return email that basically said "Can you do part of the work for me?".


I'm still completely flabbergasted by the response.  Why is my attempt to protect my happiness and my time not respected?  Why am I expected to say yes to every request that comes into my inbox?

Learning to say no isn't going to be easy.  It's going to mean letting go of the need for other people to tell me how wonderful I am and what a good job I'm doing.  It's going to mean letting go of the belief that if I were just better, just like every other physician, that I would be able to say yes to everything.  It's going to mean ignoring the blogs of the overachievers, who have a medical practice and children and exercise daily and cook healthy food, and setting my own standards for achievement.  Because ultimately no one cares about my happiness as much as I do.  And no one else in Medicine is looking out for my well-being as much as I am.

Wednesday, December 21, 2016

My Anti-Consumerism Christmas

I've written before about how much I dislike gifts.  It's not that I intentionally want to be a Scrooge, it's simply that I don't have a lot of material wants and needs (by privileged North American standards), and those that I have are easily met on my physician salary.  What I want far more than a sweater that someone else picked for me or another gadget for our overflowing kitchen drawers is time.  Time to rest, time to read, time to do the 1000-piece puzzle that I ordered from Amazon.

For years, I've been trying to convince my family members to simplify Christmas by giving fewer gifts.  And for years, I've been met with a desire to maintain the status quo of everyone giving gifts to everyone else.  This year, however, possibly as a result of my years of wearing down rationally discussing my views with my family members, people have finally agreed to cut back on gift giving.  Success!

Here (in case this is interesting to you) is how it is all working out:

Girlfriend (M):  M is the one person I enjoy giving gifts to, because she has a long running list of things that she wants, which makes her really easy to buy for.  And, unlike me, she loves getting gifts.  Last year I took this way too far, to the point where it was awkward for me to give her gift after gift in front of her family members.  This year, we are giving just one larger gift and one "stocking stuffer" to each other.  Our cluttered apartment will appreciate the (relative) self restraint.

Mom:  Normally my Mom gives everyone multiple gifts, many of which end up being returned or donated to the thrift store because she bought them months earlier to "save money" and they can no longer be returned.  This year, she is planning on one physical gift for each person (maximum ~$30) and one gift card to a preferred store.  Some of the physical gifts are still of questionable quality (sorry M), but at least they are smaller, and at least the gift cards will get used.

Because I hate shopping, I once again bought my Mom season's tickets to our local theatre.  We go to the theatre six times per year, and it's a great way for us to spend some dedicated time together and to do something we both enjoy.  Way more valuable than anything I could find in a mall.

Brother and Sister-In-Law:  I consider this my biggest win of the year!  My brother and sister-in-law have crazy busy lives, which have gotten even busier since bringing home a new puppy, so I managed to sell them on the idea of no gifts between couples.  I'm far happier to spend an hour or two more with them than I would be running around trying to find them a half decent gift.

Nieces:  When I suggested to my brother that we not exchange gifts, his first reaction was "But you'll still get the girls something, right?"  To which I sighed.  Because my nieces have everything.  There is literally nothing in the world that either of them needs.  Clothes, makeup, music, movies, ski equipment, a new puppy.  They have everything.  For their birthdays this year, I copied my idea for my Mom and gave them both season's tickets to our local children's theatre.  But for Christmas?

One of the things that makes me sad about my nieces is that neither of them really reads for fun.  When I was a kid, my single favourite thing was to visit the bookmobile that would come to our neighbourhood once a week.  I would return home with shopping bags full of books, which I would then proceed to binge-read until my parents forced me to turn out the bedroom light and go to sleep.  (Sadly, I didn't own a flashlight for reading under the covers.)  I really want to get my nieces more into reading, so once again I decided to get them books for Christmas.  I was very successful with Chris Colfer's book last year, so they will probably always get books from me.  Whether they want to or not.

 And that's it.  Christmas shopping done with only two trips to the mall.  Success!

If you celebrate Christmas, how are you doing with your shopping?

Edited to add:  Ummm...or Hanukkah.  Of course.

Thursday, November 24, 2016

Gathering my People

This has been a really, really rough week.


I didn't expect it at all.  I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar.  It was supposed to be a good week.

And then we had a department meeting.

There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty.  And as an anxious person, uncertainty is not my friend.  I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*.  It's been miserable.

While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently.  I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire.  This isn't working.

Thankfully, today was a paperwork day, so I had lots of time to figure things out.  And what I figured out was that I need a support system.  People who have been through what I'm going through who can offer me some advice.  Unfortunately, in Medicine this is a really, really hard thing to find.  We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy. 

Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending.  When I realized this morning that I need more people, my brain went "Ah-ha!".  That was who I needed.  Except...she is an attending that I don't know personally.  And I run into her about once every 3-6 months. 

So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.

And she said yes.

And then I emailed another attending.  Who also said yes. 

Suddenly, after a week of feeling alone and scared, I don't feel so much of either.

*For the record, none of this is rationally necessary.  Everything is going to be fine, one way or another.  This is just anxiety.

Sunday, November 20, 2016

How Am I Doing So Far?

This week was my first week of call since I wrote my post about how to not hate call so much.  (I've been on call for 21 of the past 42 days.  Too much call.)  As the week approached, I tried very hard to say no to anything but the most essential of activities.  I deferred dinner with a friend until next week.  I said no to doing anything with my Mom.  I was ruthless with turning people down.

And then the week arrived.

Monday night a group of medical school friends whom I only see a few times a year were getting together for dinner, and I couldn't say no.

Tuesday night my girlfriend's parents invited us over for a birthday dinner.

Wednesday night a friend was visiting from Egypt and wanted to meet for dinner.

Thursday night we decided to go see a new house that had just come onto the market.

Friday night was trivia night at my girlfriend's church.  And I love trivia.

Over the weekend, we have seen three more houses, gone out for breakfast twice, gone for an impromptu coffee with my Mom and brother, watched my niece in a volleyball tournament, shopped at two craft markets, seen Romeo Dallaire speak, and gone for another birthday dinner with my girlfriend's friends*.

I apparently am incapable of just saying no to anything.  If it sound remotely interesting, and especially if it involves food, I am there.  Regardless of how tired or extroverted out I may happen to be.  Regardless of how much I need to just be quiet and still after the stress of a call week.  Regardless of what I say in my blog posts.

And yet...somehow this week worked for me.  I gave myself the option of saying no to things, but when it came time to exercise that option, I never wanted to.  I got to do a lot of fun and interesting things with people whom I love over the course of the week, and it felt pretty good.  I'm not quite sure why it was okay this time when it wasn't the last time I was on call, but somehow it was.  Maybe it was knowing that I could say no to things without guilt?  Maybe it was only being on call for one week and knowing that I would have a long stretch of recovery afterwards?

I haven't the foggiest clue, but I'm very glad it did.  And I'm hoping that it will continue to do so when the next stretch of call comes around.

Monday, November 7, 2016

Ignoring Money

As a medical trainee, I pretty much ignored my finances.  Having been a disciplined saver of at least 10% of my earnings since I turned 18, it was depressing to watch my savings first disappear and then turn into a six-figure debt.  So I didn't.  I stopped looking at my bank account, I stopped filing my taxes*, and I essentially pretended that money didn't exist.

I existed in this world of willful ignorance for eight years, until a scare at work made me question whether I was going to get to be a doctor.  Suddenly the debt that I had thought would be easy to repay grew monstrous, as I imagined paying it off without a physician's salary.  So I started paying attention.  And budgeting.  And slowly I got myself to a point where my net worth went up a bit every month.

And then I got my adult job.  And suddenly my net worth was going up a lot every month.  Within 10 months of starting as an attending, I had saved enough money to repay my debt.  It felt pretty awesome.  But it also felt pretty obsessive.  Every day when I came home from work, I would check my bank balance and my credit card balance and my payment owed balance to figure out how much I was worth.

Every single day.

It got to the point that I was attaching too much of my self worth and feelings of security/insecurity to a single number.  On days when I'd have a good clinic (or, even better, have a good clinic and be on call), I'd feel happy, confident that I was moving towards a future of security and happiness.  On days when I'd pay my rent or my car insurance, however, I'd be miserable.  Any downward movement in my net worth felt like a failure.

So I stopped looking.

For all of October, I kept my net worth file closed and simply ignored it.  I kept tracking my earnings and my spending, and I must admit that I tried to mentally estimate my net worth a few times, but I didn't check my net worth obsessively.  And it felt so much better.  I didn't get angry at patients who failed to show to clinic, viewing them as a lost revenue stream.  I didn't get upset when I had to, or chose to, spend money.  I knew that, regardless of what was happening day to day, overall my net worth was going in the right direction.

I was going to be fine.

Ironically, October had the second biggest net worth increase of any month since I started working.  This was in no way related to my behaviour, and in every way related to the 15 days of call that I worked, but it was still really comforting to know that I could let go of my hypervigilance about money, and it would still be okay.

Now that October is over, and I can check my net worth as often as my heart desires, I'm trying hard to not fall back into my old patterns.  I don't want my happiness to be tied to money.  I don't want to be anxious on the days when my spending exceeds my earnings - which is every single weekend day.  I don't want to be constantly comparing myself to all the personal finance bloggers and feeling inadequate.  I want my money to be in the background, slowly growing, while my much more exciting and fulfilling life goes on in the foreground.

*This is a really, really dumb thing to do. 


Wondering what my November goal is?  ABSOLUTELY NOTHING.  I'm feeling burnt out at the moment, and all I can think about is spending four days this weekend at a cabin with my girlfriend.  And books.  And nachos!

Self improvement will have to wait for December.

Sunday, October 23, 2016

Surviving Call

When I wrote my most recent blog post, I was feeling a little bit smug about how well my life was going.  I was exercising, I was feeling calm, and my relationship was in pretty much the best state it has ever been.  I was happy.  I was about to start an 11-day stretch of 24-hour-a-day call, but I felt ready for it.

I've got this, I thought.

Except I didn't.  It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level.  I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves.  (How dare they?)  After weeks of respite, my mind was back to ramped-up panic mode.

And that's where it remained for most of my 11 days on call.  I worried and obsessed over the decisions I was making.  I felt stressed by the increasing pile of undictated charts piling up on my desk.  I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough.  As it often is, it was awful.

And of course, my life outside of work suffered.  My relationship that had, until that point, been ticking along nicely, suddenly struggled.  I was short-tempered.  Everything she did seemed wrong and irritating.  I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well.  Also awful.

In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year.  Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call.  I want my life on call to still feel okay.

So I've been thinking a lot about the things that I can do to make call less awful.  This is what I've come up with so far:

Undercommit:  I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities.  Evenings on my couch with a book and my cats are as essential to me as vitamins.  This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life.  Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.

The other downside to making plans when I'm on call is that I hate disappointing anyone.  Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me.  It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.

I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations.  I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.

Keep moving:  It always comes back to this.  Exercise is good.  I need to do it.  Regularly.  End of story.

Talk to M:  I have a really good partner who is loving and supportive and a good listener.  I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.

Let things go:  The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole.  I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book.  And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!

I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch.  I can eat a fried egg with toast or a frozen fish fillet and the world will not end.  Pozole can wait for a week when I'm not on call.  As can many other things.  Call weeks should be about doing what is necessary, not what is perfect.

Recognize my irrationality:  I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life.  When I'm in the extremes of my anxiety, it can lead me to think really irrational things.  Like that my relationship may not be a good one.  Or I'm not cut out to be a doctor.  Or I'm going to end up on the street if I don't hoard every penny I earn.  Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.

Keep going to counseling:  I am somewhat amazed at the difference that six counseling sessions made in my life.  It probably saved my relationship with M.  It certainly made work better.  It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.

Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth.  Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go.  I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.

UTTERLY AND COMPLETELY STUPID.  (I'm looking at you when I say that, Solitary.)

For now, call is done, and I am recovering on my couch with my computer/books and Callie.  It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.

Hopefully my next time on call will be better.

Monday, October 10, 2016

Movement - September Goal

Oh exercise, how I struggle with you.  With just a quick look through the blog, it's easy to find multiple posts in which I'm either committing to exercising more or lamenting the fact that I've failed at exercising more (see here, here, here, here, and here for just a few examples).  It's not a habit that comes easily to me.

The problem, for me, is that there are so many things that I would rather being doing than exercising.  Reading, blogging, cuddling with my cats and/or girlfriend, eating out, cooking at home, etc. etc.  There is no shortage of things that I want to do, and it is always difficult to say no to them in order to do something that doesn't really appeal to me.

But I know I need to.  For my stress level, for my health, for my happiness.  Everything is better when I get exercise.  So this month, I set myself the goal of exercising three times a week.  I didn't set any specific requirements for how long or what type of exercise or anything else, I simply had to move.  And I'm happy to report that I was almost perfect.  In the entire month, I only missed one workout, and that was due to the fact that I had such bad sciatic pain that I could barely walk.

In addition to working on the habit, I wanted to observe myself and figure out what helped me/hindered me when it came to exercise.  I want to better understand why I've failed in the past so that hopefully I can do better at making this a lifelong habit.  If nothing else, it will be much more interesting for the blog if I can set a monthly goal for myself that isn't exercising!  Here's what I learned over the past month:

Variety:  I've tried in the past to just run on the treadmill in my building three times per week, and it gets boring very quickly.  (Not to mention the bloody sciatic pain.  My borderline obese body was not designed for running.)  This time I've been trying to do more variety - walking outside, yoga classes, aerobics classes, elliptical - and it's definitely easier to stay motivated.

Planning:  I do much better if I sit down at the beginning of the week and plan out my exercise than if I just try to wing it.  Not surprisingly.  (I didn't promise that these would be profound observations, just observations.)

Changes in Schedule:  I have been aiming for a Tuesday/Thursday/Saturday exercise schedule, which is great when it works, but terrible if I happen to have an extra morning clinic or something else that interferes with my plans.  Going forward, I'm going to have to get better at dealing with the things that throw me off of my schedule.  (Case in point:  I have an 8 am lecture to attend tomorrow, combined with our local LGBTQ film festival in the evening, and I have no idea how to deal with it yet.)

Mood:  My mood has been vastly better over the past month than it has been in perhaps ever.  While I think the counseling and the improvements in my relationship have played a huge part, I certainly don't want to discount the role that exercise is probably playing.

So, for the first time in ever, let's call this month of exercising a success!


As for October (quick comment before rushing off to Thanksgiving dinner #2), my goal is to not look at my net worth.  Not once.  I normally check it on a daily basis and think about it pretty obsessively, so going 31 days without looking at it is a big step for me.  But one that has been good so far, and one that I think is necessary for my happiness.

Happy Thanksgiving to everyone in Canada!  Hope you enjoy your turkey (or Aloo Gobi, which is how we're celebrating this year).